Left heart bypass reduces paraplegia rates after thoracoabdominal aortic aneurysm repair

Background. The optimal strategy for spinal cord protection during thoracoa bdominal aortic aneurysm (TAAA,) repair remains unclear. We evaluated the p rotective effect of left heart bypass (LHB) during repair of extensive TAAA s. il Methods. During a 12-year period, 710 patients had repair of extent I or IT TAAAs. Left heart bypass was used in 312 (43.9%) patients. This group was retrospectively compared with 398 (56.1% ) patients who had operations with out LHB. Results. The overall 30-day survival rate was 94.8% (673 patients). In 42 p atients, (6.0%) paraplegia or paraparesis developed. In patients with exten t I TAAAs, paraplegia and paraparesis rates in LHB (6 of 123, 4.9%) and non -LHB (9 of 246, 3.7%) groups were similar (p = 0.576) despite longer aortic clamp times in the former group. In patients with extent II TAAAs, the LHB group had a lower incidence of paraplegia or paraparesis (9 of 189, 4.8%) compared with the non-LHB group (18 of 137, 13.1%; p = 0.007). Conclusions. Left heart bypass reduced the risk of paraplegia and parapares is in patients who had repair of extent I and II TAAAs. (C) 1999 by The Soc iety of Thoracic Surgeons.